7. PLAN DE ANÁLISIS DE RESULTADOS
7.2. Plan de tabulación y análisis
Costs of medical care have risen in the last decades, and cost-effectiveness analyses have gotten more attention. Especially for expensive therapies applied in advanced melanoma, such as immunotherapy and targeted therapies, a number of cost- effectiveness studies have been published [58-60]. It can be concluded from these studies that these therapies are not cost-effective, but would be if the prices of these drugs approached the thresholds for every gained quality adjusted life year (QALY). However, some treatment protocols in melanoma lack evidence and we can wonder whether these protocols are effective, let alone cost-effective. For example, the standard histopathological examinations of re-excision specimens of completely excised melanomas do not increase treatment efficacy, but cost approximately α80 per examination in the Netherlands. Furthermore, there is no evidence for the benefit of re-excisions in patients with melanoma in situ, and limited evidence for re-excisions in thin melanomas (i.e., with a Breslow thickness ≤ 1 mm) [24]. It would be interesting to further investigate whether re-excisions could be omitted in some cases, both from an ‘evidence based medicine’ point of view and to spare medical costs.
Another example include follow-up schedules: the Dutch guideline advises a follow-up of at least 5 years after the diagnosis of a melanoma thicker than 1 mm [7] despite the fact that most new events are discovered by patients themselves [61, 62] [7]. Also, one can wonder how cost-effective sentinel lymph node biopsies (SLNBs) are, since the benefit of this procedure in terms of overall survival remains uncertain. Moreover, with respect to the previous paragraph, effective primary prevention strategies will likely be cost-effective, as high costs spent on diagnosis and treatment of (metastasised) melanoma are spared.
With the rising incidence of melanoma and the rising costs of medical care, it is important to decide how to spend our money. Therefore future studies investigating treatments or diagnostic procedures in melanoma should include cost-effectiveness analyses.
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